Association between stress hyperglycemia ratio and all-cause mortality among ICU patients with sepsis: a systematic...

The stress hyperglycemia ratio (SHR) is defined as the admission blood glucose level divided by the estimated average glucose derived from glycated hemoglobin (HbA1c). Previous studies have demonstrated that higher SHR levels are associated with increased all-cause mortality among intensive care unit (ICU) patients. However, the relationship between SHR and mortality risk specifically in patients with sepsis remains controversial.

This study aimed to systematically evaluate, through a systematic review and meta-analysis, the association between SHR and all-cause mortality among adult ICU patients with sepsis.

A comprehensive search was performed in PubMed, Web of Science, Embase, and the Cochrane Library databases. The methodological quality of included studies was assessed using the Newcastle-Ottawa Scale (NOS). A random-effects model was employed to pool relative risks (RR) with corresponding 95% confidence intervals (CIs). All statistical analyses were conducted using Stata version 18.0.

A total of 11 retrospective cohort studies comprising 37,790 participants were included. Pooled analyses showed that higher SHR levels were significantly associated with increased risks of in-hospital mortality (RR = 2.11, 95% CI: 1.79-2.50; I ² = 36.3%), short-term mortality (RR = 1.56, 95% CI: 1.38-1.77; I ² = 0%), and long-term mortality (RR = 1.52, 95% CI: 1.40-1.65; I ² = 10.3%). Subgroup analyses based on follow-up duration (60 days, 90 days, and 1 year) revealed no statistically significant differences in effect size (p = 0.511), suggesting that follow-up duration was not a major source of heterogeneity. Meta-regression analysis indicated that studies with a higher proportion of diabetic patients showed a stronger association between SHR and in-hospital mortality (p = 0.026). The overall methodological quality of the included studies was high.

This systematic review and meta-analysis demonstrated that elevated SHR is an independent predictor of in-hospital, short-term, and long-term all-cause mortality among ICU patients with sepsis. SHR, as a simple and valuable prognostic biomarker, may aid in early risk stratification of patients with sepsis.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420251139874, Identifier CRD420251139874.